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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

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Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

24-DECEMBER-2011  AHMAD MAJEED SALEH  29 YEARS  INJURY TO THE RADIAL NERVE LOWER THIRD OF THE LEFT ARM.

Anamnesis

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The patient came from Iraq-Baghdad 03-September-2011 complaining of complete drop left wrist and hand after explosion 28-August-2011. He came with a sling and POP above the left elbow with X-rays showing chip fracture of the left humerus lower third lateral aspect.

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On examination, the patient had complete non function of the left radial nerve including the brachioradialis muscle with anaesthesia of the left radial nerve territory. The patient was given nonsteroids and medications to improve the nerve regeneration.

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The patient then came 21-September-2011 with ECS confirming that there is complete axonal damage to the left radial nerve. The patient was advised to wait for another month and he came 25-October-2011 with new ECS  confirming signs of reinnervation of the left brachioradial muscle. The patient was advised to wait another 2 months and he came 21-December-2011 with new ECS confirming that, there is no changes in the recovery process. Surgical exploration was advised.

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Projection incision upon the affected area of the left radial nerve. The distal part of the radial nerve was isolated between the brachialis and radiobrachial muscles. The proximal part of the radial nerve above the affected site was identified. Using ISIS Inomed Neurosxplorer the distal part of the nerve was studied. Upon stimulation with 2mA DNS the brachioradial muscle was responding well. The other muscles below this level were showing very weak response upon stimulation with 15 mA, which could be explained by retrograde stimulation of other muscles. Dissection down and up from the distal part was proceeded until it was clear that the branch to the radiobrachial muscle was emerging above the neuroma. It was anatomically preserved and separate check for its function showed good response of the brachioradial muscle. Studying the radial nerve at the neuroma level and below showed no response. The neuroma was cut. until the distal and proximal stumps showed good fibrillary structure. The gap was 17 mm in length. Putting the elbow in slight flexion, end to end anastamosis was achieved without tension. Using 4 zero and 6 zero nylon the stumps were stitched with good cooptation.

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The rounded shrapnel was removed from the left heel under the control of C-arm.

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Routine closure of the wounds. Smooth postoperative recovery.


Follow Up

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The patient came 01-August-2013 for evaluation, telling that he stopped medication the last 2 months. The patient has full motor recovery of the left affected limp. He could dorsiflex the left wrist and extend the fingers. There was a small spot of anaesthesia in the web of the thumb of the left hand.

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If to give estimation of the degree of recovery, then it will be 95%, which is excellent for radial nerve repair.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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The patient had injury tot eh left radial nerve with shrapnel's and chip fracture of the bone, reflecting the severity of the injury. Early intervention was not recommended, because there was swelling and a cast in the injured area.

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The recovery of the left brachioradial muscle could be explained by the emergence of its neural supply above the damaged area. This was confirmed by the operative findings.

 


Schematic representation of the lesion. Notice the neuroma is under the emergence of the brachioradial muscle branch.

 


Back Up!

Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

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